Provider Demographics
NPI:1215570288
Name:CLEVELAND, ZACHARY ALEXANDER DALE
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ALEXANDER DALE
Last Name:CLEVELAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 LAKE JOAN CIR
Mailing Address - Street 2:
Mailing Address - City:MUNFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36268-7154
Mailing Address - Country:US
Mailing Address - Phone:256-252-7902
Mailing Address - Fax:
Practice Address - Street 1:255 LAKE JOAN CIR
Practice Address - Street 2:
Practice Address - City:MUNFORD
Practice Address - State:AL
Practice Address - Zip Code:36268-7154
Practice Address - Country:US
Practice Address - Phone:256-252-7902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2021-047103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst